Possible denial--help with ideas please!

Hi! I have Uniform Medical Insurance. When I was accepted into the program  (Jan 07) I gave a the nurse a starting wgt which later turned out to be low. I called the nurse and left a message that the initial weigh in wgt should have been higher--never heard back from the nurse about that. This was in Mar or April of this year. In April nurse called me to say "I'm ready for you to find a doctor and to schedule you for your appt and then surgery." I was thrilled. No discussion of how it was going with losing 5% of my total wgt. Saw surgeon in May and scheduled the surgery date for July with pre op on 7-3-07.  Last Friday, 6-8-07, received a call from nurse, Uniform Medical nurse, saying that Medical Director was not approving my surgery! Reason given was I hadn't lost the required 5% and their chart indicated I had actually gained 50 lbs. I was amazed and heartsick. No explanation of where the 50 lbs gain had come from either. They were calling to cancel my surgery. Tearfully I begged her not to do that until I had spoken/seen my doctor. She agreed. I scheduled an appt with my regular doc for tomorrow 6-11-07. This morning I called the Uniform nurse back and informed her of the appt and further discussed where the 50 lbs came. She couldn't find my chart and wasn't certain how the 50 lbs had been calculated and then hit me with Uniform had no edit button for her to change or correct things from the initial intake and that was likely part of the problem. Hope this makes sense. Then she hit me with the denial on 6-8-07 was a permanent denial--no surgery. Good grief how could this be.  Please help with any ideas you might have. I have no problem accepting the %5 being my issue but Uniform needs to have fulfilled their part also. I don't remember anywhere where it was discussed one time "If you don't make it the first time you're out."  Please note not once was wgt loss discussed with me after  the first intake. No one said, wrote, etc. about you're not meeting the 5%.  Please give me any suggestions you might have. I'm devastated. Thank you. Faye

I'm so sorry this happened to you!  Is it possible for you to write an appeal letter or something to them - or ask your doctor to do so or help you out in some way? 

Thank you for your reply. I have an appt with my doctor tomorrow and we'll see what she has to say. I'm hoping she has some suggestions. I'll also check into the appeal process. Again my thanks.

Check out www.obesitylaw.com/.  They may be able to help you.  If you have even only one chance for an appeal, you certainly don't want to blow it.  It may be worth it to actually even spend money with them if you can't find something helpful off of their site.  I've heard of others who've only needed them to draft a letter and they get the go-ahead for surgery. Good luck! Lori